Crohn病の経過中に十二指腸病変が発見の契機となった二次性アミロイドーシスの1例

Secondary Amyloidosis Found by Routine Duodenoscopy during the Course of Crohn's Disease, Report of a Case

要旨　Crohn病の経過観察中に上部消化管内視鏡検査で指摘された十二指腸病変が発見の契機となった二次性アミロイドーシスを経験した．患者は34歳，男性．1984年，Crohn病と診断され小腸部分切除を施行された．発症後約15年経過した1994年4月，Crohn病増悪のため入院した．上部消化管内視鏡検査で十二指腸第2部にKerckring皺襞の不整像，小顆粒の集簇した粘膜を斑状に認めアミロイドーシスと診断した．生検組織像では粘膜固有層にアミロイド沈着を認め，病理学的に二次性アミロイドーシスと診断された．全経過を通して腎障害はなく尿蛋白は陰性で，臨床的に消化管以外の障害は認めなかった．

　The patient was a 34-year-old man who had been diagnosed as having Crohn's disease and underwent partial ileal resection in 1984. In April, 1994, he developed obstructive symptoms and was admitted to our hospital. He was diagnosed as having amyloidosis by a routine upper endoscopic examination by findings of irregularity of the Kerckring's folds and fine granular mucosa on the second portion of the duodenum.

　Histological examination revealed a deposition of amyloid substance in the propria mucosae and he was diagnosed as having secondary amyloidosis. He has not suffered from proteinuria and disorders of the other organs during the course of Crohn's disease. Hence, endoscopic abnormalities can be the first clue to secondary amyloidosis.